Background: Primary hepatic angiosarcoma is a rare malignant vascular tumor with nonspecific clinical manifestations, making early diagnosis challenging.
Case presentation: A 69-year-old man with a 3-year history of stage 4 chronic kidney disease presented with nonspecific symptoms. Laboratory investigations revealed anemia and eosinophilia, while liver function tests, coagulation profile, hepatitis B, and HIV screening were unremarkable. Imaging demonstrated an ill-defined mass in segment VII of the liver.
Intervention and outcome: The patient underwent ultrasound-guided liver biopsy. Histopathological examination combined with immunohistochemistry showed diffuse atypical endothelial cells expressing CD31, CD34, and ERG, confirming the diagnosis of primary hepatic angiosarcoma.
Conclusion: Primary hepatic angiosarcoma should be considered in the differential diagnosis of atypical hepatic masses. Histopathological examination combined with immunohistochemistry is essential for establishing a definitive diagnosis.